Surrender Request

Owner Surrender Request Form
Please complete one form for each animal you are requesting to surrender. If you are requesting to surrender a litter, please only do one form.

Paws of the Pines Rescue makes every attempt to find safe and loving homes for the adoptable pets surrendered to us.

Please fill out the form entirely. If admitted, the detailed and accurate information you provide us makes it easier for us to place your pet in an appropriate foster home.

This is a request form and not a surrender form.

If approved, one of our members will contact you.

We are a foster based organization and rely soley on fosters. Without foster commitments we cannot take on additional animals.

If approved, please consider a monetary donation towards the medical care of the animal(s) being surrendered.
Your Information:
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address:*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Basic Must Knows on the animal being requested to surrender:
Is this a stray animal or a personal animal?*

StrayPersonalOther
Where did you get this animal?*
How long have you had this animal in your possession? *
If this animal is a stray - have you contacted your local animal control?*
A lost pet report should be filed.
If this animal is a stray - have you contacted had this animal scanned for a microchip?*
This can be done at most vet offices.
Animal Name (If known):*
Species:*
Breed:*
Age:*
Sex: Male Female Age:*
Is this animal altered (spayed/neutered)?*

YesNoI'm not sure
Why are you surrendering this animal?*
How Does This Animal React?
Is this animal destructive when left alone?*

YesNo
If yes, please explain:
Is this animal house trained?*

YesNo
Has this animal had previous training?*

YesNo
What vet office has this animal been to?*
When was this animal last seen at the vet?*
How does this animal react when being seen by a veterinarian?*
Is this animal up to date on vaccinations?*

YesNoOther
When was this animal last vaccinated?*
What vaccines has this animal had?*
Does this animal have any known health or medical related issues?*

YesNo
If Yes please explain.
Has this animal been given any flea or tick meds?*

YesNo
If yes, what kind and when was it last given?
Has this animal been tested for heartworms?*

YesNo
When was this animal last tested for Heartworms?*
What was the heartworm test result?*

PositiveNegative
How does this animal react with Children?*
How does this animal react to strangers?*
How does this animal react to visitors in the home?*
How does this animal react if you try to take away a toy or bone?*
How does this animal react if you take the animals food while eating?*
Does this animal have any food aggression?*

YesNo
If Yes explain.
How does this animal react if disturbed while sleeping?*
Any additional comments:
Is this animal friendly:*

YesNo
Does this animal get along with:*

Large DogsSmall DogsPuppiesFemale DogsMale DogsCatsFarm AnimalsOther
If yes, please explain this animals experience with other animals:*
If no, please explain:*
Does your this animal have behavior issues?*

YesNo
If yes, please explain:*
What has frightened or scared this animal?*
How does this animal react when being groomed?*
How does this animal react to having his/her nails trimmed?*
Has this animal ever bitten anyone?*

YesNo
If yes, did it break skin?*

YesNo
Was a bite report filed?*

YesNo
Please explain the bite incident:*
Please list a few things you like best about this animal:*
Questions for you:
Why do you think this animal would be a good candidate for our rescue?*
Are you willing to help us help this animal if accepted into our rescue?*
If Yes, please select what you are WILLING to do:

Foster for 1-2 weeksFoster for 1 monthFoster until a home is foundDonate towards the care of the animalCover the cost of food until a home is foundCover the medical cost associated with the animal
Please upload at least 3 photos of the animal you are wanting to surrender.*

Cancelof
By signing this form, I state that I am the person currently with ownership of the animal who is the subject of this Animal Surrender Request Form. To my knowledge, no other person has a right to this animal. By signing this form, I agree to allow Paws of the Pines Rescue 72hrs to make their deicison to accept or deny my request. I understand my request may be denied with no explanation. I understand that while I allow Paws of the Pines Rescue 1 week to decide and respond. I will not rehome this animal until this has been reviewed and responded to by Paws of the Pines Rescue. I understand if my request is approved, this form will be used for intake of my animal and that I surrender all rights to this animal. I understand that if approved, my rights are relinquished and this animal belongs to Paws of the Pines Rescue. I understand that the animal will not be available to be returned to me should I change my mind.

I have read and understand the terms of this Animal Surrender Request Form.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Your Information:

Basic Must Knows on the animal being requested to surrender:

How Does This Animal React?

Questions for you: